PubMed Health⌕ Search

Biomedical subjects

J M Orgogozo

Publications and source records attributed to J M Orgogozo.

At least 55 records · Page 3Linked to original sources
PubMed1998

Advantages and disadvantages of neurological scales.

The neurological features demonstrated by a patient form a valid measurement for the level of impairment experienced following a stroke. These features can be assessed using neurological scores, which assign values to the many deficits exhibited by such patients and allow a prognosis to be made on patient outcome. Several stroke scales have been produced, most of which are based on normative scaling. While these stroke scales provide effective patient assessment, they do have some associated disadvantages. The analysis of multiple minor deficits can lead to the same scoring as a few major deficits, some scales assess stroke only on a small number of items. In addition, most scales operate best in the middle range of stroke severity and have limited value in mild and severe cases. Despite these drawbacks, neurological scores give an earlier and more sensitive response to the outcome of stroke than functional scales. They are powerful prognostic indicators in stroke. Most of them are equivalent, which allows comparison between studies.

Cerebrovascular Disorders↗
PubMed1997

Cognitive predictors of dementia in elderly community residents.

Detection of subjects with a high risk of developing dementia is a major goal of epidemiological research. Among the potential predictors, minor cognitive impairments detected by psychometric methods could be important precursors. A total of 2,726 elderly nondemented subjects, aged 65 and over, randomly selected from the general population of Gironde (south-western France) were followed up for 3 years. During this time, 84 developed an incident dementia, diagnosed as Alzheimer's disease (AD) in 59. The relationships between cognitive performance (Mini Mental State Examination, Benton Visual Retention Test and Isaacs Set Test) measured at the baseline screening of the cohort and the risk of dementia or AD were studied with a discrete Cox proportional hazard model. After adjustment for age and educational level, the three test scores remained strongly related to the risk of dementia or AD. Psychometric performance can be used to screen subjects at risk of developing dementia or AD and allow pharmacological intervention at an early stage.

Activities of Daily Living↗
PubMed1997

Treatment of acute ischemic stroke with piracetam. Members of the Piracetam in Acute Stroke Study (PASS) Group.

BACKGROUND AND PURPOSE: Piracetam, a nootropic agent with neuroprotective properties, has been reported in pilot studies to increase compromised regional cerebral blood flow in patients with acute stroke and, given soon after onset, to improve clinical outcome. We performed a multicenter, randomized, double-blind trial to test whether piracetam conferred benefit when given within 12 hours of the onset of acute ischemic stroke to a large group of patients. METHODS: Patients received placebo or 12 g piracetam as an initial intravenous bolus, 12 g daily for 4 weeks and 4.8 g daily for 8 weeks. The primary end point was neurologic outcome after 4 weeks as assessed by the Orgogozo scale. Functional status at 12 weeks as measured by the Barthel Index was the major secondary outcome. CT scan was performed within 24 hours of the onset of stroke but not necessarily before treatment. Analyses based on the intention to treat were performed in all randomized patients (n = 927) and in an "early treatment" population specified in the protocol as treatment within 6 hours of the onset of stroke but subsequently redefined as less than 7 hours after onset (n = 452). RESULTS: In the total population, outcome was similar with both treatments (the mean Orgogozo scale after 4 weeks: piracetam 57.7, placebo 57.6; the mean Barthel Index after 12 weeks: piracetam 55.8, placebo 53.1). Mortality at 12 weeks was 23.9% (111/464) in the piracetam group and 19.2% (89/463) in the placebo group (relative risk 1.24, 95% confidence interval, 0.97 to 1.59; P = .15). Deaths were fewer in the piracetam group in those patients in the intention-to-treat population admitted with primary hemorrhagic stroke. Post hoc analyses in the early treatment subgroup showed differences favoring piracetam relative to placebo in mean Orgogozo scale scores after 4 weeks (piracetam 60.4, placebo 54.9; P = .07) and Barthel Index scores at 12 weeks (piracetam 58.6, placebo 49.4; P = .02). Additional analyses within this subgroup, confined to 360 patients with moderate and severe stroke (initial Orgogozo scale score < 55), showed significant improvement on piracetam in both outcomes (P < .02). CONCLUSIONS: Piracetam did not influence outcome when given within 12 hours of the onset of acute ischemic stroke. Post hoc analyses suggest that piracetam may confer benefit when given within 7 hours of onset, particularly in patients with stroke of moderate and severe degree. A randomized, placebo-controlled, multicenter study, the Piracetam Acute Stroke Study II (PASS II) will soon begin.

Acute Disease↗
PubMed1997

Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area.

Alcoholism is a possible cause of dementia, mainly through associated nutritional deficiencies and, rarely, through acute direct toxicity. However alcohol consumption was not found to be a risk factor in previous epidemiologic studies. We prospectively studied 3,777 community residents aged 65 and over, in the districts of Gironde and Dordogne. Average daily alcoholic consumption was recorded at baseline. Incident cases of dementia and Alzheimer's disease were screened at follow-up with explicit criteria. At 3 years, 2,273 subjects not demented at baseline were still available for follow-up. Wine was the only alcoholic beverage reported by more than 95 p. 100 of regular drinkers. In the 318 subjects drinking 3 to 4 standard glasses per day (> 250 and up to 500 ml), categorized as moderate drinkers, the crude odds ratio (OR) was 0.18 for incident dementia (p < 0.01) and 0.25 for Alzheimer's disease (p < 0.03), as compared to the 971 non-drinkers. After adjusting for age, sex, education, occupation, baseline MMSE and other possible confounders, the ORs were respectively 0.19 (p < 0.01) and 0.28 (p < 0.05). In the 922 mild drinkers (< 1 to 2 glasses per day) there was a negative association only with AD, after adjustment (OR = 0.55; p < 0.05). The inverse relationship between moderate wine drinking and incident dementia was explained neither by known predictors of dementia nor by medical, psychological or socio-familial factors. Considering also the well documented negative associations between moderate wine consumption and cardiovascular morbidity and mortality in this age group, it seems that there is no medical rationale to advise people over 65 to quit drinking wine moderately, as this habit carries no specific risk and may even be of some benefit for their health. Advising all elderly people to drink wine regularly for prevention of dementia would be however premature at this stage.

Aged↗
PubMed1996

Primitive malignant fibrous histiocytoma of the neck with carotid occlusion and multiple cerebral ischemic lesions.

BACKGROUND: Emergence of a malignant tumor at the site of an operation is a rare event and most often arises in association with retained foreign material. CASE DESCRIPTION: We describe a patient who 1 year after a left carotid endarterectomy for typical atheromatous lesions presented with several transient ischemic attacks with stepwise worsening of the deficit and rapid death. A few weeks before, a tumor of the neck had appeared at the site of the previous endarterectomy. At postmortem examination, we found a malignant histiocytofibroma occluding the left carotid artery, with several recent ischemic foci in the corresponding cerebral hemisphere without metastasis or tumor emboli. CONCLUSIONS: This observation is unusual owing to the histological type of the neoplasm and to the circumstance of emergence of the neoplasm.

Aged↗
PubMed1995

[Neurologic manifestations of Lyme disease. Apropos of 25 cases].

We studied retrospectively the cases of neurological forms of Lyme disease observed in two internal and two neurological departments from 1986 till 1993. Twenty five cases have been collected among 15 men and ten women whose mean age was 61 years. Tick bites were previously noticed in 11 cases. Erythema chronicum migrans (ECM) was mentioned in 16 cases mostly on lower limbs. The mean time between ECM and the onset of neurological symptoms was less than 1 month in 11 cases, 2 months in three cases, and 6 months in two cases. Neurological abnormalities were often associated in the same patient. Hyperalgic radiculitis (n = 16), mainly noticed in the ECM territory (n = 10) was only sensitive in six cases and associated with motor deficit in ten. Atypical polyradiculoneuritis was achieved in six cases. Clinical (n = 5) or biological (n = 22) meningitis could occur: CSF was clear with pleiocytosis (132 per mm3), mainly lymphocytic, and hyperproteinorachia (1.2 g/l) with normoglycorachia. An increase of the CSF immunoglobulins G with oligoclonal fragmentation was noticed in 11 cases. Cranial neuropathy was frequent: VII (n = 8), VI (n = 2), III, IV, VIII (n = 1). Encephalitis (with white matter demyelination) resolved partially in two cases. Diagnosis was always confirmed by Borrelia burgdorferi serology (indirect immunofluorescence) with a significant increase of the antibodies titer (n = 17) or a CSF titer > 1/4 (n = 11). Syphilitic serology was always negative. All patients were treated with parenteral beta lactamins and four with corticosteroids. Outcome was favorable in 20 patients with incomplete resolution of neurological symptoms in two patients.

Adult↗
PubMed1995

Double blind placebo controlled multicentre study of ginkgolide B in treatment of acute exacerbations of multiple sclerosis. The Ginkgolide Study Group in multiple sclerosis.

After an open labelled pilot study of ginkgolide B, a potent inhibitor of platelet activating factor, in the treatment of acute exacerbations of multiple sclerosis, a randomised double blind placebo controlled study was undertaken. One hundred and four patients were enrolled in the study: for seven days 43 received placebo, 29 received 240 mg/day ginkgolide B and 32 received 360 mg/day ginkgolide B. There was no statistical difference between the three groups for changes in Rankin, Kurtzke expanded disability status scale (EDSS), and Hauser ambulation index (AI) scores. Although there was a trend in favour of groups treated with ginkgolide for a change of Rankin and AI scores, it is concluded that ginkgolide B is not an effective treatment of exacerbations of multiple sclerosis.

Activities of Daily Living↗
PubMed1994

Tobacco consumption and cognitive impairment in elderly people. A population-based study.

We examined the relationship between tobacco consumption and Alzheimer's disease (AD), cognitive deficit, and memory performances in elderly community residents of southwestern France. Subjects were considered to have a cognitive deficit if they scored under 24 on the French version of the Mini-Mental State Examination, and poor memory performances if they scored under 8 on the Benton Visual Retention Test. Among the 3770 subjects who gave information about their smoking habits, only 356 (9.5%) were current smokers, 998 (26.5%) were past smokers, and 2416 (64%) were never smokers. Current smokers (odds ratio (OR) = 0.52, P < 0.001) and past smokers (OR = 0.54, P < 0.001) had a lower risk of cognitive deficit than did never smokers. However, this significant relationship disappeared after adjustment for potential confounding factors such as occupational category (OR = 0.91 (not significant) for current smokers and OR = 0.87 (not significant) for past smokers). Similar results were obtained for the risk of AD and of poor memory performances. The apparent protective effect of smoking habits on cognitive abilities could be due to a confounding effect of occupational category.

Aged↗
PubMed1994

[The international classification of WHO diseases (ICD-10) and its application in neurology (ICD-10 NA)].

The 10th Revision of the International Disease Classification (ICD-10) was published in English in September 1992 and in French in January 1993. Chapter VI (main code G) deals with diseases of the nervous system. There are 11 chapters covering the main categories of aetiologies. The subdivisions designated by the three-character codes are used to define the main diagnostic categories as divided according to aetiology, localization or symptoms. The three-character codes so formed are the legal basis for codifying causes of death in all the member states of the WHO. Supplementary 4-digit codes can be used for more precise definitions of morbidity; ICD-10 NA, the Application to Neurology, is a detailed classification of diseases of neurological origin or expression, based on the original ICD-10. Thus it also contains a table of inclusion and exclusion terms and a detailed alphabetical index. The inclusion terms are names of diseases, affections or syndromes associated with each ICD code. The exclusion terms are listed so that the disease in question is classified elsewhere. Thus it is easy to find the correct category even for similar or related diseases which may be classified in different chapters of the ICD-10 NA. The coding system of the ICD-10 NA is exactly the same as for the ICD-10 since cross-referencing requires that specialization classifications such as the ICD-10 NA derived from the ICD must have the same 3 and 4 digit codes as those in the original ICD-10. Within these limits, the 5th, 6th and 7th digits of the subdivision codes, and the generalization of multiple coding used to describe both aetiologies and manifestations, have greatly increased the discriminating power and precision of neurological diseases classification based on the parent ICD.

Disease↗
PubMed1993

PET imaging of cerebral perfusion and oxygen consumption in acute ischaemic stroke: relation to outcome.

We used positron emission tomography (PET) to assess the relation between combined imaging of cerebral blood flow and oxygen consumption 5-18 h after first middle cerebral artery (MCA) stroke and neurological outcome at 2 months. All 18 patients could be classified into three visually defined PET patterns of perfusion and oxygen consumption changes. Pattern I (7 patients) suggested extensive irreversible damage and was consistently associated with poor outcome. Pattern II (5) suggested continuing ischaemia and was associated with variable outcome. Pattern III (6), with hyperperfusion and little or no metabolic alteration, was associated with excellent recovery, which suggests that early reperfusion is beneficial. This relation between PET and outcome was highly significant (p < 0.0005). The results suggest that within 5-18 h of stroke onset, PET is a good predictor of outcome in patterns I and III, for which therapy seems limited. The absence of predictive value for pattern II suggests that it is due to a reversible ischaemic state that is possibly amenable to therapy. These findings may have important implications for acute MCA stroke management and for patients' selection for therapeutic trials.

Aged↗
PubMed1993

[Neurologic manifestations in Lyme disease. Apropos of 22 cases].

The main clinical and biological features of 22 cases of neurological forms of Lyme disease are reviewed. Radiculitis (n = 15), cranial nevritis (n = 7), meningitis (n = 5) and encephalitis (n = 4) are often associated. Tick bites were previously noticed in only 40% of cases; erythema chronicum migrans in 73%, "one to six months before the onset of neurological symptoms". Titers of Borrelia Burgdorferi antibodies were always above 1/256. Among 18 patients, DR W2 HLA haplotype was present in 15.

Female↗
PubMed1993

Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop.

Criteria for the diagnosis of vascular dementia (VaD) that are reliable, valid, and readily applicable in a variety of settings are urgently needed for both clinical and research purposes. To address this need, the Neuroepidemiology Branch of the National Institute of Neurological Disorders and Stroke (NINDS) convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (AIREN), resulting in research criteria for the diagnosis of VaD. Compared with other current criteria, these guidelines emphasize (1) the heterogeneity of vascular dementia syndromes and pathologic subtypes including ischemic and hemorrhagic strokes, cerebral hypoxic-ischemic events, and senile leukoencephalopathic lesions; (2) the variability in clinical course, which may be static, remitting, or progressive; (3) specific clinical findings early in the course (eg, gait disorder, incontinence, or mood and personality changes) that support a vascular rather than a degenerative cause; (4) the need to establish a temporal relationship between stroke and dementia onset for a secure diagnosis; (5) the importance of brain imaging to support clinical findings; (6) the value of neuropsychological testing to document impairments in multiple cognitive domains; and (7) a protocol for neuropathologic evaluations and correlative studies of clinical, radiologic, and neuropsychological features. These criteria are intended as a guide for case definition in neuroepidemiologic studies, stratified by levels of certainty (definite, probable, and possible). They await testing and validation and will be revised as more information becomes available.

Brain↗